The goal of GHESKIO-Cornell ICOHRTA training program is to increase capacity in integrated clinical, operational, and health services research in support of Haiti's national scale-up of HIV and tuberculosis services. Haiti is the poorest country in the Western Hemisphere and has the highest rates of both HIV infection and tuberculosis. It is estimated that 3% of the adult population isHIV- infected and that the prevalence of tuberculosis is 402/100,000 population (100xUS rates). In response to this epidemic, the Haitian Ministry of Health asked GHESKIO to form a national HIV and TB Network, a collaboration of 32 public and private health care organizations across the country that is charged with "scaling-up" to provide a standardized package of HIV and tuberculosis services to 500,000 persons by 2014. The services include voluntary counseling and HIV testing, management of tuberculosis and sexually transmitted infections, prevention of mother to child HIV transmission, and comprehensive HIV care of children, adolescents, and adults. The Haitian Ministry of Health has asked GHESKIO (Haitian Study Group for the Study of Kaposi's Sarcoma and Opportunistic Infections) to lead this network through training, supervision, monitoring and evaluation, and through the conduct of operational and health services research. GHESKIO is an international research and training institution that has benefited from 25 years of uninterrupted NIH funding and research capacity building with Cornell University, and support from the Fogarty International Center. GHESKIO is recognized as a center of research excellence, and is a member of the NIH HIV Vaccine Trials Network (VTN), the AIDS Clinical Trials Group (ACTG) and a recipient of support from the United Nations Global Fund for AIDS, TB and Malaria and the President's Emergency Plan for AIDS relief (PEPFAR). In the current proposal, GHESKIO will continue as the primary training institution and extend research capacity to other organizations in Haiti that are participating in the GHESKIO HIV and Tuberculosis Network. The program will continue to emphasize medium- and long-term training in Haiti. Since its inception four years ago the ICOHRTA has provided training to 120 Haitian biomedical personnel, all of whom are working in Haiti, providing HIV/TB services and conducting operational and health services research. GHESKIO, in collaboration with Haitian and International partners, will develop training curricula in clinical, operational, and health services research methodology and in ethics, program management, and scientific writing. A Masters in Public Health Degree program, established with ICOHRTA support, will continue to be offered in Haiti by Quisqueya University, in partnership with GHESKIO and Cornell University. PUBLIC HEALTH RELEVANCE: The specific areas of integrated clinical, operational, and health services research that will form the basis of the proposed ICOHRTA training program include: 1) adult antiretroviral treatment;2) prevention of mother to child HIV transmission and antiretroviral treatment of HIV- infected mothers and infants;3) tuberculosis with emphasis on multidrug resistant TB and HIV co- infection;4) AIDS malignancies;5) adolescents and HIV/AIDS;and 6) behavioral research. Research training will focus on translating models of HIV and TB care and prevention to large-scale national implementation.